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Case Reports: Adverse drug reactions and complications
Elexacaftor, tezacaftor and ivacaftor: a case of severe rash and approach to desensitisation
  1. Ann Cheng1,2,
  2. Olivia Baker2 and
  3. Uta Hill2
  1. 1Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
  2. 2Cambridge Centre for Lung Infection, Royal Papworth Hospital, Cambridge, UK
  1. Correspondence to Dr Uta Hill; uta.hill1{at}nhs.net

Abstract

We present a case of severe rash following induction of elexacaftor, tezacaftor and ivacaftor (ELX/TEZ/IVA) in a young adult male cystic fibrosis patient. While rash is a commonly reported side effect which resolves in 1–2 weeks with minimal intervention, our patient had presented with fever and widespread rash prompting medication cessation. After a washout period, reintroduction with 1/2 tablet of ELX/TEZ/IVA produced a similar systemic response within 24 hours. Repeat attempt, this time with 1/8 tablet and increasing in increments of an eighth daily, was successful and has allowed our patient to experience the transformative benefits of ELX/TEZ/IVA including improved pulmonary function and reduced episodes of infective exacerbation. This case illustrates one of the most common side effects of ELX/TEZ/IVA triple therapy, and our experience of desensitisation to ELX/TEZ/IVA in a challenging case of rash.

  • cystic fibrosis
  • drugs: respiratory system
  • unwanted effects / adverse reactions

https://doi.org/10.1136/bcr-2021-247042

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    Footnotes

    • Contributors AC and OB provided substantial contributions to the conception of the work and the acquisition of data. The manuscript was drafted by AC, with critical revision provided by OB and UH. All authors approved the final version to be published and agreed to be accountable for all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.